Dental Pediatric - 75293AR1230001 Health Insurance Plan
USAble Mutual Insurance Company health insurance plan with the Plan ID 75293AR1230001. The plan is called Dental Pediatric.
| Health Insurance Plan ID | 75293AR1230001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Arkansas | ||||||||||||||||||
| Health Insurance Issuer | USAble Mutual Insurance Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 75293AR1230001-01 | ||||||||||||||||||
| Provider Network(s) | TRUE-BLUE-PPO PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Thu, 10 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of Dental Pediatric Health Insurance Plan, 75293AR1230001-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
Quantitative limit units apply |
YES | 20.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per 6 Months |
YES | No Charge after deductible |
25.00% Coinsurance after deductible |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
Quantitative limit units apply |
YES | 50.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Routine Dental Services (Adult)
|
NO |
Dental Pediatric Health Insurance Plan Variant 75293AR1230001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 0.991 |
| First Tier Utilization | 100% |
| HIOS Product ID | 75293AR123 |
| Import Date | 2024-10-10 20:01:47 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 75293 |
| Issuer Marketplace Marketing Name | Arkansas Blue Cross and Blue Shield |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | Not Applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $20 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $20 |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | per person not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $425 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $425 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | Not Applicable |
| Metal Level | High |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | ARN003 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Benefit reduction for dental care by non-contracted providers |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 75293AR1230001-01 |
| Plan Level Exclusions | See Policy for Details |
| Plan Marketing Name | Dental Pediatric |
| Plan Type | PPO |
| Plan Variant Marketing Name | Dental Pediatric |
| QHP/Non QHP | Both |
| Service Area ID | ARS002 |
| Source Name | SERFF |
| Plan ID | 75293AR1230001 |
| State Code | AR |
Copay & Coinsurance of Dental Pediatric Health Insurance Plan, 75293AR1230001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Dental Pediatric, 75293AR1230001 Health Insurance Plan, 75293AR1230001
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Does Dental Pediatric Health Insurance Plan, 75293AR1230001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75293AR1230001) Health Insurance Plan, Variant (75293AR1230001-01) have Out Of Country Coverage?
Does (75293AR1230001) Health Insurance Plan, Variant (75293AR1230001-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API